sábado, 25 de febrero de 2012

FRED EasyPort

The Worlds First Pocket Defibrillator

The Defibrillator so small and light that it fits
in a coat pocket and still meets all the requirements of a modern day
AED.

Light – Only 490g (including battery)

Small – only 133 X 126 X 35 mm

High Resolution LCD

Its small size and light weight make the FRED® EasyPort the ideal
companion for physicians, tour guides, golf courses, hikers, aircraft, and other
areas where light portability is of the essence.

Its portability and size means that at risk patients can cary their own AED,
greatky reducing the response time to treat ventricular fibrillation and
tachycardias. granting the victims a much better chance of survival.

The FRED Easyport AED from Schiller because of its small
size and light weight is intended for use by basic life support responders,
healthcare professionals, such as doctors, paramedics and public service
staff.

sábado, 18 de febrero de 2012

Seizure
treatment study: Implications for EMS

Being able to use an auto-injector can simplify the
procedure and speed up the delivery time

By Art Hsieh

Seizures are a common call for EMS systems. Often the physical manifestations
of the seizure activity is over by the time we arrive; rarely do we have to
manage the more serious condition of status epilepticus.

Because of its commonality, we might not consider the impact that seizures
can have upon the patient, long after we managed their acute condition.
An advance like this has the potential to dramatically improve the overall
health of the individual, and possibly reduce the need for emergency
services.
There are also implications for EMS providers as well. It can be a challenge
to administer an intravenous benzodiazepine when the patient is actively
seizing.
Being able to use an auto injector can simplify the procedure and speed up
the delivery time. It might also mean that terminating an active seizure might
become a basic life support procedure. This can improve a system's overall
ability to respond to these common calls.
That time might be some ways off. However, it's another interesting
development in our business that benefits both patients and providers
alike

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P
currently teaches at the Public Safety Training Center, Santa Rosa Junior
College in the Emergency Care Program. In the profession since 1982, Art has
worked as a line medic and chief officer in the private, third service and
fire-based EMS. He has directed both primary and EMS continuing education
programs. A Past President of the National Association of EMS Educators, former
Chief Executive Officer of the San Francisco Paramedic Association, and a
scholarship recipient of the American Society of Association Executives, Art is
a published textbook author, has presented at conferences nationwide, and
continues to provide patient care at a rural hospital-based ALS system. Contact
Art at Art.Hsieh@ems1.com.

Study: Injection offers faster help for seizure patients Results probably will change how seizures are treated by paramedics

Expert Analysis

Seizure treatment study: Implications
for EMS

By Art Hsieh

Seizures are a common call for EMS systems. Often the
physical manifestations of the seizure activity is over by the time we arrive;
rarely do we have to manage the more serious condition of status
epilepticus.

Because of its commonality, we might not consider the impact
that seizures can have upon the patient, long after we managed their acute
condition.

An advance like this has the potential to dramatically improve
the overall health of the individual, and possibly reduce the need for emergency
services.

SAN FRANCISCO — Injecting patients in the thigh with a drug-loaded syringe
is a safe and effective way to stop a seizure in an emergency, according to
results of a national study released Wednesday, a finding that could pave the
way toward making such syringes as widely available as EpiPens used to treat
severe allergic reactions.
The two-year study, published in the New England Journal of Medicine,
concluded that a single stab from an auto-injector was more effective in
stopping a prolonged seizure than the traditional method of inserting an
intravenous line and delivering the drug directly into the bloodstream.
The results probably will change how such seizures, which can be
life-threatening if they're not stopped right away, are treated by paramedics.
But they could have more long-term repercussions if doctors start giving the
auto-injectors to epileptic patients, some of whom have several severe seizures
a year, to use at home, much as people with severe allergies carry epinephrine
syringes with them.
"I don't think we're ready to hand these out at epilepsy clinics for people
to take home right now," said Dr. J. Claude Hemphill, chief of neurology at San
Francisco General Hospital, who led the San Francisco arm of the study. "But
that may be a follow-up some folks want to do."
The U.S. Department of Defense also has taken special interest in the study,
because auto-injectors would be much more convenient than IV drug treatment in a
large-scale bioterrorism attack involving seizure-inducing nerve gas.
"The advantage is you can give it the auto-injection faster," said Dr. Walter
Koroshetz, deputy director of the National Institute of Neurological Disorders
and Stroke. "If you have 100 people simultaneously seizing, no way can you do
all those IVs. But you could just run around and inject everybody for their
seizures."
Seizures are caused by a disruption in the brain's electrical system, and in
most cases they resolve themselves after a minute or so. Roughly 2 percent of
Americans have epilepsy, a condition marked by chronic seizures.
Some seizures, known as status epilepticus or prolonged seizures, can last
several minutes or longer, and they may require drugs to stop them. More than
50,000 people in the United States die from prolonged seizures every year,
either from brain damage due to the seizure itself or from accidents related to
passing out mid-attack.
The study, which was funded primarily by the National Institutes of Health,
involved 79 hospitals nationwide, including several in the Bay Area. More than
4,000 paramedics were trained to participate in the study and 893 patients were
treated.A drug and a placeboEvery patient was given both the
auto-injector shot, usually to the thigh, and an intravenous injection. But in
half the cases the auto-injector was filled with a placebo, and in the other
half the IV drug was a placebo. Neither patients nor paramedics knew which
treatment was the placebo in any given case.
Researchers found that 73 percent of patients who were given the
auto-injector drug had stopped seizing by the time they reached the emergency
room; 63 percent of patients who got the IV drug were seizure-free.
Patients who were given the auto-injector drug were less likely than the IV
group to be admitted to the hospital after their seizure.
"This auto-injection should be the new standard of care," said Dr. James
Quinn, a professor of surgery and emergency medicine at Stanford who led the
study there. "It's great when you can do a study and it's probably going to
change how we do things."
Although two different drugs were used in the trial - midazolam for the
auto-injector and lorazepam for the intravenous injection - researchers don't
believe that the drugs made a difference in how effective the treatments were.
Rather, they said, the auto-injectors are simply easier to use.
It's much simpler to give a single shot than to try to start an intravenous
line on a patient who is actively convulsing, doctors and paramedics said. In
the study, 42 patients did not receive the intravenous treatment because the
paramedic couldn't start the IV, whereas only five patients didn't receive the
auto-injector shot because the syringe malfunctioned.
"It takes time to set up an IV. You have to find a vein that's going to be
good, you have to isolate the arm and hold it still, you have to clean the arm,
you have to insert the needle," said Judy Klofstad, a paramedic with the San
Francisco Fire Department who participated in the study. "If you're really good,
it can take 2 1/2 minutes."
Paramedics took on average just 20 seconds to use the auto-injector,
according to the study. "You just hold their thigh down, target it, and it can
go right through their clothing, through jeans even," Klofstad said.
Doctors said that because the auto-injection drug causes heavy sedation and
can lead to respiratory problems and low blood pressure, more research is needed
before the syringes are handed out to patients.
But Tiffany Manning, who has epilepsy and suffers a prolonged seizure every
two or three months, said she's excited about someday being able to carry around
an auto-injector. Her doctor at the UCSF epilepsy clinic has prescribed an oral
drug that her parents can give her when she has a seizure, but it can be
time-consuming and difficult to measure out the proper dosage and make sure she
swallows it, she said.
"And when I wake up I have a funny taste in my mouth," said Manning, 30. "My
doctor doesn't prescribe it very often. You can overdose someone on it. ... I'd
rather just have a shot in the leg."

viernes, 17 de febrero de 2012

Preparing for Your Trip to the Dominican Republic

Before visiting the Dominican Republic, you
may need to get the following vaccinations and medications for
vaccine-preventable diseases and other diseases you might be at risk for at your
destination: (Note: Your doctor or health-care provider will determine
what you will need, depending on factors such as your health and immunization
history, areas of the country you will be visiting, and planned activities.)
To have the most benefit, see a health-care provider at least 4–6 weeks
before your trip to allow time for your vaccines to take effect and to start
taking medicine to prevent malaria, if you need it.
Even if you have less than 4 weeks before you leave, you should still see a
health-care provider for needed vaccines, anti-malaria drugs and other
medications and information about how to protect yourself from illness and
injury while traveling.
CDC recommends that you see a health-care provider who specializes in Travel
Medicine. Find a
travel medicine clinic near you. If you have a medical condition, you should
also share your travel plans with any doctors you are currently seeing for other
medical reasons.
If your travel plans will take you to more than one country during a single
trip, be sure to let your health-care provider know so that you can receive the
appropriate vaccinations and information for all of your destinations. Long-term
travelers, such as those who plan to work or study abroad, may also need
additional vaccinations as required by their employer or school.Be sure your routine vaccinations are
up-to-date. Check the
links below to see which vaccinations adults and children should get.Routine vaccines, as they are often
called, such as for influenza, chickenpox (or varicella), polio,
measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at
all stages of life; see the childhood
and adolescent immunization schedule and routine
adult immunization schedule.
Routine vaccines are recommended even if you do not travel. Although
childhood diseases, such as measles, rarely occur in the United States, they are
still common in many parts of the world. A traveler who is not vaccinated would
be at risk for infection.

Vaccine-Preventable Diseases

Vaccine recommendations are based on the
best available risk information. Please note that the level of risk for
vaccine-preventable diseases can change at any time.

Recommended for all unvaccinated people traveling to or working in countries
with an intermediate or high level of hepatitis A virus infection (see
map) where exposure might occur through food or water. Cases of
travel-related hepatitis A can also occur in travelers to developing countries
with "standard" tourist itineraries, accommodations, and food consumption
behaviors.

Recommended for all unvaccinated persons traveling to or working in countries
with intermediate to high levels of endemic HBV transmission (see
map), especially those who might be exposed to blood or body fluids, have
sexual contact with the local population, or be exposed through medical
treatment (e.g., for an accident).

Recommended for all unvaccinated people traveling to or working in the
Caribbean, especially if staying with friends or relatives or visiting smaller
cities, villages, or rural areas where exposure might occur through food or
water.

Recommended for travelers spending a lot of time outdoors, especially in
rural areas, involved in activities such as bicycling, camping, or hiking. Also
recommended for travelers with significant occupational risks (such as
veterinarians), for long-term travelers and expatriates living in areas with a
significant risk of exposure, and for travelers involved in any activities that
might bring them into direct contact with bats, carnivores, and other mammals.
Children are considered at higher risk because they tend to play with animals,
may receive more severe bites, or may not report
bites.

Malaria

Areas of the Dominican Republic with Malaria: All
areas (including resort areas), except none in the cities of Santiago and Santo
Domingo.
If you will be visiting an area of the Dominican Republic with malaria, you
will need to discuss with your doctor the best ways for you to avoid getting
sick with malaria. Ways to prevent malaria include the following:

Taking a prescription antimalarial drug

Using insect repellent and wearing long pants and sleeves to prevent
mosquito bites

Sleeping in air-conditioned or well-screened rooms or using
bednets

All of the following antimalarial drugs are equal options for preventing
malaria in the Dominican Republic: Atovaquone-proguanil, chloroquine,
doxycycline, or mefloquine. For detailed information about each of these
drugs, see Table
3-11: Drugs used in the prophylaxis of malaria. For information that can
help you and your doctor decide which of these drugs would be best for you,
please see Choosing a
Drug to Prevent Malaria.
To find out more information on malaria throughout the world, you can use the
interactive CDC malaria
map. You can search or browse countries, cities, and place names for more
specific malaria risk information and the recommended prevention medicines for
that area.

Malaria Contact for Health-Care Providers
For
assistance with the diagnosis or management of suspected cases of malaria, call
the CDC Malaria Hotline: 770-488-7788 (M-F, 9 am-5 pm, Eastern time). For
emergency consultation after hours, call 770-488-7100 and ask to speak with a
CDC Malaria Branch clinician..

More Information About Malaria

Malaria is always a serious disease and may be a deadly
illness. Humans get malaria from the bite of a mosquito infected with the
parasite. Prevent this serious disease by seeing your health-care provider for a
prescription antimalarial drug and by protecting yourself against mosquito bites.
Travelers to malaria risk-areas in the Dominican Republic, including infants,
children, and former residents of Dominican Republic, should take one of the
antimalarial drugs listed in the box above.

Symptoms

Malaria symptoms may include

fever

chills

sweats

headache

body aches

nausea and vomiting

fatigue

Malaria symptoms will occur at least 7 to 9 days after being bitten by an
infected mosquito. Fever in the first week of travel in a malaria-risk area is
unlikely to be malaria; however, you should see a doctor right away if you
develop a fever during your trip.
Malaria may cause anemia and jaundice. Malaria infections with Plasmodium
falciparum, if not promptly treated, may cause kidney failure, coma, and
death. Despite using the protective measures outlined above, travelers may still
develop malaria up to a year after returning from a malarious area. You should
see a doctor immediately if you develop a fever anytime during the year
following your return and tell the physician of your travel.A Special Note about Antimalarial Drugs
You should purchase your antimalarial drugs before travel. Drugs purchased
overseas may not be manufactured according to United States standards and may
not be effective. They also may be dangerous, contain counterfeit medications or
contaminants, or be combinations of drugs that are not safe to use.
Halofantrine (marketed as Halfan) is widely used overseas to treat malaria.
CDC recommends that you do NOT use halofantrine because of
serious heart-related side effects, including deaths. You should avoid using
antimalarial drugs that are not recommended unless you have
been diagnosed with life-threatening malaria and no other options are
immediately available.
For detailed information about these antimalarial drugs, see Choosing a Drug to
Prevent Malaria.

Items to Bring With You

Medicines you may need:

The prescription medicines you take every day. Make sure
you have enough to last during your trip. Keep them in their original
prescription bottles and always in your carry-on luggage. Be sure to follow
security guidelines, if the medicines are
liquids.

Antimalarial drugs, if traveling to a malaria-risk
area in Dominican Republic and prescribed by your doctor.

Medicine for diarrhea, usually over-the-counter.

Note: Some drugs available by prescription in the US are illegal in other
countries. Check the US Department of State Consular Information Sheets for the country(s) you
intend to visit or the embassy or consulate for that country(s). If your
medication is not allowed in the country you will be visiting, ask your
health-care provider to write a letter on office stationery stating the
medication has been prescribed for you.

Lightweight long-sleeved shirts, long pants, and a hat to wear outside,
whenever possible.

Flying-insect spray to help clear rooms of mosquitoes. The product should
contain a pyrethroid insecticide; these insecticides quickly kill flying
insects, including mosquitoes.

Bed nets treated with permethrin, if you will not be sleeping in an
air-conditioned or well-screened room and will be in malaria-risk areas. For use
and purchasing information, see Insecticide
Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another
insecticide, deltamethrin, may be purchased to treat bed nets and
clothes.

Other Diseases Found in the CaribbeanRisk can vary between countries within this region
and also within a country; the quality of in-country surveillance also
varies.

The following are disease risks that might affect travelers; this is not a
complete list of diseases that can be present. Environmental conditions may also
change, and up to date information about risk by regions within a country may
also not always be available.Dengue
epidemics have occurred on many of the Caribbean islands. Most islands are
infested with Aedes aegypti, so these
places are at risk for introduction of dengue. Protecting yourself against
insect bites (see below) will help to prevent this
disease.
In 2006, malaria
(falciparum) was confirmed in travelers
to Great Exuma, Bahamas, and Kingston, Jamaica, areas where malaria transmission
typically does not occur. An outbreak of eosinophilic meningitis caused by
Angiostrongylus cantonensis occurred in
travelers to Jamaica.
Cutaneous larval migrans is a risk for travelers with exposures on beaches
and leptospirosis
is common in many areas and poses a risk to travelers engaged in recreational
freshwater activities. Such activities may include whitewater rafting,
kayaking, adventure racing, or hiking. Endemic leptospirosis is reported in
Jamaica. Travelers to regions in Jamaica can reduce their risk to leptospirosis
by avoiding activities which expose them to contaminated fresh surface water.
Outbreaks of ciguatera
poisoning, which results from eating toxin-containing reef fish, have
occurred on many islands.
Endemic foci of histoplasmosis
are found on many Caribbean islands, and outbreaks have occurred in
travelers.
Anthrax is hyperendemic in Haiti but has not been reported on most of the
other islands. Haiti also has a high incidence rate of tuberculosis
and high HIV
prevalence rates.

Staying Healthy During Your Trip

Prevent Insect Bites

Many diseases, like malaria
and dengue,
are spread through insect bites. One of the best protections is to prevent
insect bites by:

Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available
in 7% and 15% concentrations, needs more frequent application. There is less
information available on how effective picaridin is at protecting against all of
the types of mosquitoes that transmit malaria.

Wearing long-sleeved shirts, long pants, and a hat outdoors.

Remaining indoors in a screened or air-conditioned area during the peak
biting period for malaria (dusk and dawn).

Sleeping in beds covered by nets treated with permethrin, if not sleeping in
an air-conditioned or well-screened room.

Spraying rooms with products effective against flying insects, such as those
containing pyrethroid.

Be Careful about Food and Water

Diseases from food and water are the leading cause of illness in travelers.
Follow these tips for safe eating and drinking:

Wash your hands often with soap and water, especially before eating. If
soap and water are not available, use an alcohol-based hand gel (with at least
60% alcohol).

Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or
bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not
possible, learn how to make water
safer to drink.

Do not eat food purchased from street vendors.

Make sure food is fully cooked.

Avoid dairy products, unless you know they have been pasteurized.

Diseases from food and water often cause vomiting and diarrhea. Make sure to
bring diarrhea medicine with you so that you can treat mild cases yourself.

Avoid Injuries

Car crashes are a leading cause of injury among
travelers. Protect yourself from these injuries by:

Not drinking and driving.

Wearing your seat belt and using car seats or booster seats in the backseat
for children.

Following local traffic laws.

Wearing helmets when you ride bikes, motorcycles, and motor bikes.

Not getting on an overloaded bus or mini-bus.

Hiring a local driver, when possible.

Avoiding night driving.

Other Health Tips

To avoid infections such as HIV and viral hepatitis do not share needles for
tattoos, body piercing, or injections.

To reduce the risk of HIV and other sexually transmitted diseases always use
latex condoms.

To prevent fungal and parasitic infections, keep feet clean and dry, and do
not go barefoot, especially on beaches where animals may have
defecated.

After You Return Home

If you are not feeling well, you should see your doctor and mention that you
have recently traveled. Also tell your doctor if you were bitten or scratched by
an animal while traveling.
If you have visited a malaria-risk area, continue taking your chloroquine for
4 weeks after leaving the risk area.Malaria is always a serious disease and may be a
deadly illness. If you become ill with a fever or flu-like illness either
while traveling in a malaria-risk area or after you return home (for up to 1
year), you should seek immediate medical attention and should
tell the physician your travel history.

Important Note:
This document is not a complete medical guide for travelers to this
region. Consult with your doctor for specific information related to your needs
and your medical history; recommendations may differ for pregnant women, young
children, and persons who have chronic medical conditions.

viernes, 3 de febrero de 2012

Field Triage

Guidelines for the Field Triage of Injured Patients

Injuries affect all Americans.
They are the leading cause of death for children and adults from age 1 to 44
in the United States.
At the scene of an injury, Emergency Medical Service (EMS) professionals must
identify the severity and type of injury, and determine which hospital or other
facility would be the most appropriate to meet the needs of the patient. This is
done through a process called “field triage.”
The profound importance of daily on-scene triage decisions made by EMS
professionals is reinforced by CDC-supported research that shows that the
overall risk of death was 25 percent lower when care was provided at a Level I
trauma center than when it was provided at a non-trauma center.
Not all injured patients can or should be transported to a Level I trauma
center. Other hospitals can effectively meet the needs of patients with less
severe injuries, and may be closer to the scene. Transporting all injured
patients to Level I centers—regardless of injury severity—limits the
availability of Level I trauma center for those patients who really need the
level of care provided at those facilities. Proper field triage ensures that
patients are transported to the most appropriate healthcare facility that best
matches their level of need.
In 2009, the Centers for Disease Control and Prevention (CDC) published
guidance on the field triage process in “Guidelines for Field Triage of Injured
Patients, Recommendations of the National Expert Panel on Field Triage” in the
Morbidity and Mortality Weekly Report (MMWR).
The updated Guidelines, published in the newly released MMWR reflect the
results of the Panel’s deliberations and include changes made upon the best
available evidence, and incorporate the experiential base that CDC has developed
through its close work with states, national organizations, communities, and
individual professionals.
The 2011 Guidelines for the Field Triage of the Injured Patient initiative is
developed to give EMS leaders and professionals the tools they need to implement
and adopt the 2011 Guidelines.